MEDICARE: QINGGEN ZHANG LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	2007035068	MO

General Provider Information

NPI Number	:	1184911109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QINGGEN ZHANG LAC

Provider Business Mailing Address
First Line	:	520 HUBER PARK CT
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-8621
Country	:	US
Telephone Number	:	636-675-9688
Fax Number	:	636-329-8977

Provider Business Practice Location Address
First Line	:	520 HUBER PARK CT
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-8621
Country	:	US
Telephone Number	:	636-675-9688
Fax Number	:	636-329-8977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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